Geriatric disease prevention and nursing training report

The core priority of geriatric disease prevention and control is "compliance over standardization". We abandon the application of one-size-fits-all diagnosis and treatment guidelines and adjust the intervention plan based on the elderly's living habits, personality characteristics, and family support. The final chronic disease control efficiency is 62% higher than that of the control group that implements the standardized plan.

We didn’t believe this conclusion at first, until we met Uncle Li who loved to play chess. He is 72 years old and has grade 3 hypertension. The previous plan given by the sphincter nurse was to measure blood pressure three times every morning, noon and evening, eat no pickled products at all, and walk for 30 minutes after meals. He has not done this for half a year, and his blood pressure is around 160/95mmHg every time he comes to dispense medicine. We followed nurse Zhang to visit his home twice and found out that he had to go to the community park to play chess for three hours every day. Before going out in the morning, he was worried about taking his blood pressure and not occupying his seat. Pickled radish has been a side dish for breakfast for 40 years. Taking a walk was not as interesting as playing two games with an old friend. Later, we moved the blood pressure measurement point to the duty post at the entrance of the park. He could take the test while he was playing chess. We also made him a chess-shaped time card, stamped with a "pawn" stamp after each measurement. If he saved 20 blood pressure, he would be given a customized set of chess pieces. We did not stop him completely. We reduced the number of pickled radish from one plate a day to half a plate a day, and drank it with his favorite warm tea. After less than two months of adjustment, his blood pressure stabilized at around 135/85mmHg. Even his wife laughed and said, "I used to persuade him to measure his blood pressure as if it would cost him his life, but now he is more proactive than anyone else."

In fact, there is still quite a quarrel in the industry regarding this priority issue. During our training, the Municipal Health Commission happened to hold an internal seminar. Clinical experts insisted that we must strictly follow the evidence-based standards of the 2023 "Guidelines for the Diagnosis and Treatment of Hypertension in the Elderly in China". They said that strict implementation can reduce the risk of stroke by 32%. Relaxing the requirements at will is irresponsible for the health of the elderly; working as a community elderly Nursing doctors and nurses generally stand on the other side and show the city's community nursing data just surveyed in 2024: the compliance rate of the elderly who fully comply with the guidelines is only 17%, and the compliance rate of the plan with personalized adjustments can reach 68%. Calculated, the final actual prevention and control effect is 11% higher than the strict implementation of the standards. Both sides are supported by data, and no one can convince the other. Our experience after training is that there is no black-and-white answer when it comes to the front line. If the old man has strong self-discipline and can accept the standard requirements, it is best to follow the guidelines. If the old man is highly resistant, it is better to follow his habits first, which is worse than not implementing it at all.

In addition to chronic disease management, the most common aspect of this training was accident risk prevention, especially falls and foreign objects stuck in the throat. At the beginning, we prepared a PPT lecture according to the textbook. The old people sitting at the bottom either dozed off or chatted. After half an hour of lecture, we asked if anyone remembered that anti-slip mats should be installed in toilets. Half of the people raised their hands and said that even if they are installed at home, they are still slippery. Later, we simply moved the simulation scene for practical training to the community square, and put out the soft-soled slippers, rugs with ruffled edges, and small steps in the entrance that are common in the elderly's homes, and asked the elderly to walk them by themselves to see if they were slippery and tripped. In less than half an hour, several elderly people said on the spot that they would throw away the rugs with ruffled rugs at home. It was even more interesting when we were teaching the Heimlich maneuver. We used a simulation model to demonstrate, and the elderly came over to watch, and some took the initiative to try it. Last week, the teacher who taught the Heimlich maneuver told us that a grandmother Wang who had learned the technique at that time happened to meet her husband when she got her throat stuck after eating glutinous rice balls. She used the techniques she learned to take pictures on the spot and sent a banner to the community.

I used to memorize the nursing guide in school, and always felt that all indicators must be controlled within the standard range to be qualified. When I arrived at the training site, I realized that there were too many things to consider. There is an 80-year-old diabetic grandma. Her family members always say that she secretly hides sweets to eat, but no matter how hard they scold her, we came to her home and chatted for a long time before we found out that her family was poor when she was a child and she had never eaten sweets. Now that she is older, she wants something sweet. If you don't let her eat it, she will secretly search for cream cakes in the cupboard while her children are at work. It is more dangerous to have high and low blood sugar. Later, we discussed with her family and put two sucrose-free orange hard candies in her pocket every day, and took one out when she wanted to eat. With such a small adjustment, her blood sugar was stabilized for more than half a month. Another family member bought an electric nursing bed worth over RMB 10,000 for an old man. The old man thought it was troublesome to operate and never used it, so he insisted on sleeping on the hard bed he had slept on for decades. We later adjusted the height of the nursing bed to the same height as the hard bed, and added a wooden armrest that he was used to. Now he is willing to lie in bed for two hours every day, and he can swing it up to watch TV.

My biggest feeling after this training is that the prevention and care of geriatric diseases is essentially to make friends with the living habits of the elderly, rather than as opponents. There is never a perfect, one-size-fits-all plan, and there is no need to worry about whether it meets a certain standard. As long as the elderly are willing to cooperate, have stable physical indicators, and live a comfortable life, it is the best plan. To put it bluntly, what we care for is not "senile diseases", but the elderly who are sick. This is something I can't learn in textbooks.